National achievements

Clinicians at UHDB have been shortlisted for a national award for their work to establish community breast pain clinics, aimed at providing better care for patients and reducing unnecessary suspected cancer referrals.

The East Midlands Mastalgia Pathway Implementation Team, which consists of colleagues from UHDB and other regional healthcare colleagues, has been shortlisted for the ‘Primary and Community Care Innovation of the Year’ Award at the 2022 HSJ Awards for their work in creating a new pathway for patients with troublesome breast pain.

Patients accessing this new pathway are referred to a specialist clinic as opposed to urgent cancer diagnostic pathways. This allows patients solely with breast pain to safely access alternative, more appropriate local care, and provides patients with reassurance that breast pain alone is not a symptom of breast cancer. The clinics provide a full clinical assessment, a family history risk assessment and breast pain management advice.

Professor John Robertson, Professor of Surgery at University of Nottingham and Consultant Breast Surgeon at UHDB, said: “The number of patients being referred to two-week wait cancer pathways across the country is rising and placing increased demand on an already stretched system. However, up to 20% of the referrals into our breast cancer service were for women presenting solely with breast pain as a symptom, which is not indicative of cancer.

“This was placing patients with breast pain under undue anxiety and stress, incorrectly concerned that they may have breast cancer, as well as adding congestion to a growing waiting list for urgent clinic appointments. We devised this pathway to help relieve patients of this burden, and also help to free up valuable time for hospital breast teams across the region.”

It is anticipated that, nationally, around 130,000 women are placed on suspected cancer pathways because of breast pain alone, with around 80% of women expected to experience this at some stage during their life; yet breast pain alone is not a concerning symptom in relation to breast cancer.

Professor Robertson added: “Reducing these referrals into secondary care helps to save around 20% of the capacity of two-week wait cancer diagnostic clinics. This is also really important as it allows patients who do have suspected or confirmed cancer to access treatment in a timelier manner, which is crucial as we know that earlier detection and treatment of cancer results in better outcomes. Seeing patients with breast pain in a community setting is not only better care for patients, but also financially beneficial compared to managing them in secondary care clinics.”

The initial small pilot clinic was held in Mansfield, with the learning from taken to develop a pilot that has been carried out across Derbyshire, with weekly clinics held in community settings in Derby and Chesterfield. The model has now been expanded across all centres in the East Midlands with the help of the East Midlands Cancer Alliance. Locally, the first clinic was held in Lichfield last week for patients within the Burton catchment area.

Mrs Veronica Rogers, Advanced Nurse Practitioner at UHDB, who sees patients in the breast pain clinics said: “The patient feedback and level of satisfaction for women attending these clinics has been excellent. It is really satisfying to be able to provide a quality service for these worried women away from the cancer diagnostic clinics” 

Mr Mark Sibbering, Consultant Breast Surgeon at UHDB, said: “Since the community breast pain clinics were implemented, we have seen some really good, promising outcome data. This new way of working will improve care for many patients and as well as saving precious NHS resources and money.

“There are around 14 other cancer alliances across the country who are looking to roll this model out further too, and our estimations are that nationally, it could save up to £9 million annually.”

The team also expressed their gratitude to colleagues across the healthcare system for their help in making the project a success.

Mr Sibbering added: “The amount of collaborative work that has gone into this project has been huge. There’s been so much shared learning and cross-organisational working between colleagues in primary and secondary care, between NHS trusts and commercial healthcare companies, pharmaceutical and diagnostic companies – and not least between UHDB and the University of Nottingham. So, I’d like to thank everyone who has been involved.

"It was really pleasing for the work of the team to be recognised at the 2022 UHDB Annual Making a Difference Awards, where we won the Research, Innovation and Quality Improvement Award.”

The team will now attend the HSJ Awards ceremony on Thursday 17 November at Evolution, London, to find out if they have been chosen as winners.